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09/18/2015 FRI 10: 22 FAX Fast water Heater 0002/002 <br /> 0 9 <br /> PERMIT APPLICATION �j�121 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEDODtR 1 S: E r� c POE X fl 2 O h PERMIT Ln y()'� <br /> LEGAL for new conotruotlort, Short Pl&t/eubdivielon Lot No. (attach copy of long legal deocrlptlon) <br /> OWNER20APhone/E-mall lt�Z <br /> Addrees THCity/State/Zlp V -r <br /> APPLICANT:—Owner Ownnr's Agent\4Contra/cltor —Con tractor'6 Agent _Tenant(must areVlde a loner of cone Brit from the owner to do work m the apace) <br /> CONTRACTOR_fA -� n State Llc. # wW Cit Bus. Lic- <br /> I �,1 ,�j (�t� I ft D _ � /� <br /> Address I N `f t—W- S C WA <br /> Phony/Small c�� (D 3 ylrl 1 T,S fzls �-ei <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT [n�e�• <br /> 9A-r\-i Y-f-,4i ue- <br /> Phone/E-mall ` v <br /> � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK II�I.t 9 w <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas V Electric Other <br /> Building type: Slhtjle Fami _Duplex_Townhouse Multi-Family _Commercial <br /> Type of ro ect: Addition Remodel Re air T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo or Project: _Now_Addn `Altoratlon_Repair Type of ProJeot _New_j►ddn _Alteration_Repair <br /> Show Number # of flxfurav Show Numhor # of flrturas <br /> NC-air handling units Toilet <br /> Forced airs slams Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&des osal <br /> Gas ran a Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water hBater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer Inside bld <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease try <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Number of Heads Other: <br /> I hereby certify that I have reed and examined thea application and know the eame to be true and correct.All provlslons of laws and ardinancee governing this type of work will be comp <br /> with whether epeci0ed herein or not.The gronlinp of a permit does not presume to give authority to violeto or cancel the provision of any other elate or local law regulating conalfuction <br /> nal I am authorized by the own r our property to perform the work ror which application Is mode and I comply with(he Stale Conlractora Lew 18.27 RCW any 296-200A WAC. <br /> rl� <br /> 'Ovv-nurlKuth-orlzed Agent Slgnaturo Data (Reviaed 4/2015) <br />